Transcatheter Therapies for the Treatment of Valvular and Paravalvular Regurgitation in Acquired and Congenital Valvular Heart Disease

Abstract

Transcatheter therapies in structural heart disease have evolved tremendously over the past 15 years. Since the introduction of the first balloon-expandable valves for stenotic lesions with implantation in the pulmonic position in 2000, treatment for valvular heart disease in the outflow position has become more refined, with newer-generation devices, alternative techniques, and novel access approaches. Recent efforts into the inflow position and regurgitant lesions, with transcatheter repair and replacement technologies, have expanded our potential to treat a broader, more heterogeneous patient population. The evolution of multimodality imaging has paralleled these developments. Three- and 4-dimensional visualization and concomitant use of novel technologies, such as fusion imaging, have supported technical growth, from pre-procedural planning and intraprocedural guidance, to assessment of acute results and follow-up. A multimodality approach has allowed operators to overcome many limitations of each modality and facilitated integration of a multidisciplinary team for treatment of this complex patient population.

Implantation of right ventricular endocardial pacing lead via paravalvular leak and subsequent paravalvular leak closure in a patient with mechanical tricuspid valve

“…PVL is a common complication after prosthetic valve replacement, and significant tricuspid PVL is rare [3] . Limited data suggest that significant paravalvular regurgitation with progressive right heart failure warranted surgical or transcatheter treatment [4] . In addition, the pacing lead going through paravalvular defect might worsen paravalvular regurgitation.…”

“… 3 Limited data suggest that significant paravalvular regurgitation with progressive right heart failure warranted surgical or transcatheter treatment. 4 In addition, the pacing lead going through the paravalvular defect might worsen paravalvular regurgitation. Therefore, simultaneous percutaneous closure of the PVL was performed.…”

Cardiac arrest in patient with significant pulmonary regurgitation after surgical valvulotomy at 10 years of age for isolated pulmonary stenosis

“…Perkutánní implantace pulmonální chlopně (PPVI) je možnou alternativou k izolované chirurgické PVR u pacientů, kteří mají biologickou protézu nebo konduit (většinou homograft, může jít i o xenograft) s významnou stenózou nebo regurgitací [9,10]. Momentálně je v klinickém užívání nejdéle chlopeň Melody (Medtronic) s dobrými krátkodobými i dlouhodobými výsledky a nově i chlopeň Edwards SAPIEN.…”

Mitral clip–looking back and moving forward

“…However, advanced age, LV dysfunction, or comorbidities preclude surgery in up to 50% of patients, who until recently would have been treated conservatively [4]. The advent of transcatheter mitral repair and replacement has created new therapeutic options for these high-risk patients, with multiple devices in varying stages of development [5][6][7]. With over 25 000 patients treated worldwide, the MitraClip (Abbott Vascular, IL, USA) is the most established device for transcatheter mitral repair and will be the focus of this review.…”